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Hulskotte LMG, Wilbrink-Pijffers I, Arbouw MEL, Benoist GE, Jansman FGA, van Berlo-van de Laar IRF. A rapid and sensitive LC-MS/MS method for quantifying oxycodone, noroxycodone, oxymorphone and noroxymorphone in human plasma to support pharmacokinetic drug interaction studies of oxycodone. Biomed Chromatogr 2024:e5874. [PMID: 38587098 DOI: 10.1002/bmc.5874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
A sensitive and reliable LC-MS/MS method was developed and validated for the quantification of oxycodone and metabolites in human plasma. The method has a runtime of 6 min and a sensitivity of 0.1 μg/L for all analytes. Sample preparation consisted of protein precipitation. Separation was performed on a Kinetix biphenyl column (2.1 × 100 mm, 1.7 μm), using ammonium formate 5 mm in 0.1% aqueous formic acid and methanol LC-MS grade 100% in gradient elution at a flow rate of 0.4 ml/min. Detection was performed in multiple reaction monitoring mode using positive electrospray ionization. The method was linear over the calibration range of 0.1-25.0 μg/L for oxycodone, noroxycodone and noroxymorphone and 0.1-5.0 μg/L for oxymorphone. The method demonstrated good performance in terms of intra- and interday accuracy (86.5-110.3%) and precision (CV 1.7-9.3%). The criteria for the matrix effect were met (CV < 15%) except for noroxymorphone, for which an additional method was applied to compensate for the matrix effect. Whole blood samples were stable for 4 h at room temperature. Plasma samples were stable for 24 h at room temperature and 3 months at -20°C. Furthermore, the method was successfully applied in a pharmacokinetic drug interaction study of oxycodone and enzalutamide in patients with prostate cancer.
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Affiliation(s)
- Lotte M G Hulskotte
- Department of Clinical Pharmacy, Deventer Teaching Hospital, Deventer, The Netherlands
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | | | - Maurits E L Arbouw
- Department of Clinical Pharmacy, Deventer Teaching Hospital, Deventer, The Netherlands
| | - Guillemette E Benoist
- Department of Clinical Pharmacy, Deventer Teaching Hospital, Deventer, The Netherlands
| | - Frank G A Jansman
- Department of Clinical Pharmacy, Deventer Teaching Hospital, Deventer, The Netherlands
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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Cloesmeijer ME, van den Oever HLA, Mathôt RAA, Zeeman M, Kruisdijk-Gerritsen A, Bles CMA, Nassikovker P, de Meijer AR, van Steveninck FL, Arbouw MEL. Optimising the dose of clonidine to achieve sedation in intensive care unit patients with population pharmacokinetics. Br J Clin Pharmacol 2020; 86:1620-1631. [PMID: 32150285 PMCID: PMC7373711 DOI: 10.1111/bcp.14273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/13/2020] [Accepted: 02/26/2020] [Indexed: 01/15/2023] Open
Abstract
Aims The aim of this study was to investigate the population pharmacokinetics (PK) of clonidine in intensive care unit (ICU) patients in order to develop a dosing regimen for sedation. Methods We included 24 adult mechanically ventilated, sedated patients from a mixed medical and surgical ICU. Intravenous clonidine was added to standard sedation in doses of 600, 1200 or 1800 μg/d. Within each treatment group, 4 patients received a loading dose of half the daily dose administered in 4 hours. Patients gave an average of 12 samples per individual. In total, 286 samples were available for analysis. Model development was conducted with NONMEM and various covariates were tested. After modelling, doses to achieve a target steady‐state plasma concentration of >1.5 μg/L were explored using stochastic Monte Carlo simulations for 1000 virtual patients. Results A 2‐compartment model was the best fit for the concentration‐time data. Clearance (CL) increased linearly with 0.213%/h; using allometric scaling, body weight was a significant covariate on the central volume of distribution (V1). Population PK parameters were: CL 17.1 (L/h), V1 124 (L/70 kg), intercompartmental CL 83.7 (L/h), and peripheral volume of distribution 178 (L), with 33.3% CV interindividual variability on CL and 66.8% CV interindividual variability on V1. Simulations revealed that a maintenance dose of 1200 μg/d provides target sedation concentrations of >1.5 μg/L in 95% of the patients. Conclusion A population PK model for clonidine was developed in an adult ICU. A dosing regimen of 1200 μg/d provided a target sedation concentration of >1.5 μg/L.
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Affiliation(s)
- Michael E Cloesmeijer
- Department of Hospital Pharmacy - Clinical Pharmacology, Amsterdam University Medical Centres, The Netherlands
| | | | - Ron A A Mathôt
- Department of Hospital Pharmacy - Clinical Pharmacology, Amsterdam University Medical Centres, The Netherlands
| | - Marieke Zeeman
- Department of Clinical Geriatrics, Deventer Hospital, The Netherlands
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ten Bokum EM, van de Oever HLA, Radstake DWS, Arbouw MEL. Clozapine intoxication due to cessation of smoking and infection. Neth J Med 2015; 73:345-347. [PMID: 26314718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report on a patient on clozapine treatment who was admitted to our hospital with pneumonia. He had stopped smoking a few weeks before admission. The serum clozapine rose to a toxic level, most likely due to the combination of infection and smoking cessation. Physicians and pharmacists are often not aware of risk factors for decreased metabolism of clozapine.
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Affiliation(s)
- E M ten Bokum
- Department of Clinical Pharmacy, Deventer Hospital, Deventer, the Netherlands
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Hoge RHL, Arbouw MEL, Radstake SDWS, van Berlo-van de Laar IRF. Subtherapeutic serum quetiapine concentrations after absorption inhibition by binding resins: a case report. J Clin Pharm Ther 2015; 40:355-7. [PMID: 25808008 DOI: 10.1111/jcpt.12265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/02/2015] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Polystyrene sulfonate and sevelamer are binding resins that are used in the treatment of, respectively, hyperkalemia and hyperphosphatemia. It is unknown whether these resins interact with the antipsychotic quetiapine. CASE SUMMARY We report on a woman with unexplainable low serum quetiapine concentrations who also used the binding resins polystyrene sulfonate and sevelamer. An In vitro binding assay showed binding of quetiapine by these resins. Separation of the ingestion times of quetiapine and the binding resins resulted in increased serum levels in this patient. WHAT IS NEW AND CONCLUSION Polystyrene sulfonate and sevelamer are able to bind quetiapine. Healthcare professionals should be aware of this potential drug-drug interaction as this could lead to antipsychotic treatment failure.
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Affiliation(s)
- R H L Hoge
- Department of Clinical Pharmacy, Deventer Hospital, Deventer, The Netherlands; Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands; Competence Centre for Translational Peptide Research U-PEP, Ulm, Germany
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van Berlo-van de Laar IRF, Arbouw MEL, Bles CMA. [Strychnine poisoning: uncommon, but does still happen]. Ned Tijdschr Geneeskd 2015; 159:A8877. [PMID: 26173662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Acute strychnine poisoning is an uncommon form of intoxication, characterized by severe tonic clonic seizures and tetanus-like contractions while the patient is fully conscious. It can result in respiratory failure, leading to death. CASE DESCRIPTION A 47-year-old man was admitted to the casualty department 2 hours after self-poisoning with strychnine. The clinical picture consisted of persistent seizures, which were treated with midazolam and propofol. The patient went into respiratory failure and asystole, so intubation and cardiac massage were initiated. Other complications were severe metabolic acidosis, hyperthermia and rhabdomyolysis with renal failure. The treatment consisted of cooling, hyperhydration and intravenous administration of sodium bicarbonate. He was discharged to a mental care institution with no persistent symptoms 11 days later. CONCLUSION Early aggressive treatment of a strychnine intoxication can be life-saving. Knowledge of the clinical picture and the right treatment is important. Treatment is primarily focussed on stopping the convulsions and securing the airway.
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Arbouw MEL, Hoge HL, Meulenbelt J, Jansman FGA. Increase of baclofen intoxications: risks involved and management. Neth J Med 2014; 72:497-499. [PMID: 25431397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Baclofen has been increasingly used in the treatment of alcohol withdrawal syndrome (AWS). We present a patient with AWS and psychiatric comorbidity who ingested 700 mg of baclofen. ICU admission was necessary for ventilatory support and symptomatic treatment. The patient was dismissed without sequelae.
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Affiliation(s)
- M E L Arbouw
- Department of Clinical Pharmacy, Deventer Hospital, Deventer, the Netherlands
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Arbouw MEL, Movig KLL, Guchelaar HJ, Neef C, Egberts TCG. Dopamine agonists and ischemic complications in Parkinson's disease: a nested case-control study. Eur J Clin Pharmacol 2011; 68:83-8. [PMID: 21779969 PMCID: PMC3249169 DOI: 10.1007/s00228-011-1084-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 06/07/2011] [Indexed: 01/11/2023]
Abstract
Background It has been suggested that ergoline dopamine agonists can cause ischemic complications. The effect of dopamine agonists in general on the prevalence of ischemic events in patients with Parkinson’s disease (PD) has not been studied. Objective Our aim was to investigate the association between the use of dopamine agonists and hospitalization due to ischemic events in patients with PD. Methods We performed a nested case–control study using the PHARMO Institute for Drug Outcome Research database. All patients issued at least one prescription for levodopa after the age of 55 years between 1994 and 2006 were initially identified. Cases were patients who were hospitalized for the first time after November 1997 for an ischemic event and were matched to as many as four controls. Exposure to dopamine agonists during the year preceding the index date was identified. Results The study population consisted of 542 cases and 2,155 controls. The mean effect of dopamine agonist use 1 year prior to the index date on ischemic events requiring hospitalization is shown with 95% probability in the 0.95–1.49 range. Stratified results according to the type of dopamine agonist showed no risk differences between ergoline and nonergoline agonists. Conclusions This study does not support an association between dopamine agonist use and an increased risk of ischemic events requiring hospitalization.
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Affiliation(s)
- Maurits E L Arbouw
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
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Arbouw MEL, Movig KLL, Egberts TCG, Poels PJE, van Vugt JPP, Wessels JAM, van der Straaten RJHM, Neef C, Guchelaar HJ. Clinical and pharmacogenetic determinants for the discontinuation of non-ergoline dopamine agonists in Parkinson's disease. Eur J Clin Pharmacol 2011; 65:1245-51. [PMID: 19669131 PMCID: PMC2778789 DOI: 10.1007/s00228-009-0708-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 07/19/2009] [Indexed: 11/04/2022]
Abstract
Objective To identify determinants for the discontinuation of non-ergoline dopamine agonist (DA) treatment in patients with Parkinson’s disease (PD) and to identify genetic determinants in genes encoding dopamine receptor (DR)D2 and DRD3 in a exploratory analysis. Methods Patients included were first-time users of the non-ergoline DA ropinirole or pramipexole who had been diagnosed with PD before 2005. Treatment discontinuation was defined as a gap of 180 days or more between two refills of the DA. Non-genetic determinants for discontinuation were studied in the overall population, and genetic determinants [DRD2 141C Ins/Del, DRD2 (CA)n STR, DRD2 TaqIA, DRD3 MscI single nucleotide polymorphism (SNP) and DRD3 MspI SNP] were studied in a subgroup. Cox proportional hazard analysis was used to estimate the hazard ratios (HR) for the discontinuation of non-ergoline DA treatment. Results The study population comprised 90 patients. Apomorphine use was associated with non-ergoline DA discontinuation, although the apomorphine group consisted only of three patients [HR 6.26; 95% confidence interval (CI) 1.85–21.2]. Daily levodopa dosages between 500 and 1000 mg were positively associated with discontinuation (HR 2.31; 95% CI 1.08–4.93). Included in the exploratory pharmacogenetic analysis were 38 patients. The absence of a 15× DRD2 CA repeat allele was significantly related with a decreased discontinuation of non-ergoline treatment (HR 0.23; 95% CI 0.07–0.81). The DRD3 MspI polymorphism showed a non-significant allele dose effect, suggestive of a causal relationship. Conclusion This study identified apomorphine use and levodopa dosages between 500 and 1000 mg as non-genetic and the 15× DRD2 CA repeat allele as genetic determinants for the discontinuation of non-ergoline DA treatment in patients with PD. More research is needed to replicate these findings.
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Affiliation(s)
- Maurits E L Arbouw
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
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Arbouw MEL, Movig KLL, Koopmann M, Poels PJE, Guchelaar HJ, Egberts TCG, Neef C, van Vugt JPP. Glycopyrrolate for sialorrhea in Parkinson disease: a randomized, double-blind, crossover trial. Neurology 2010; 74:1203-7. [PMID: 20385892 DOI: 10.1212/wnl.0b013e3181d8c1b7] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Sialorrhea affects approximately 75% of patients with Parkinson disease (PD). Sialorrhea is often treated with anticholinergics, but central side effects limit their usefulness. Glycopyrrolate (glycopyrronium bromide) is an anticholinergic drug with a quaternary ammonium structure not able to cross the blood-brain barrier in considerable amounts. Therefore, glycopyrrolate exhibits minimal central side effects, which may be an advantage in patients with PD, of whom a significant portion already experience cognitive deficits. OBJECTIVE To determine the efficacy and safety of glycopyrrolate in the treatment of sialorrhea in patients with PD. METHODS We conducted a 4-week, randomized, double-blind, placebo-controlled, crossover trial with oral glycopyrrolate 1 mg 3 times daily in 23 patients with PD. The severity of the sialorrhea was scored on a daily basis by the patients or a caregiver with a sialorrhea scoring scale ranging from 1 (no sialorrhea) to 9 (profuse sialorrhea). RESULTS The mean (SD) sialorrhea score improved from 4.6 (1.7) with placebo to 3.8 (1.6) with glycopyrrolate (p = 0.011). Nine patients (39.1%) with glycopyrrolate had a clinically relevant improvement of at least 30% vs 1 patient (4.3%) with placebo (p = 0.021). There were no significant differences in adverse events between glycopyrrolate and placebo treatment. CONCLUSIONS Oral glycopyrrolate 1 mg 3 times daily is an effective and safe therapy for sialorrhea in Parkinson disease. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that glycopyrrolate 1 mg 3 times daily is more effective than placebo in reducing sialorrhea in patients with Parkinson disease during a 4-week study.
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Affiliation(s)
- M E L Arbouw
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, the Netherlands
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Arbouw MEL, Movig KLL, van Vugt JPP, Egberts TCG. Reply: long-term retention rate of pramipexole in the treatment of Parkinson’s disease. Eur J Clin Pharmacol 2009. [PMID: 19415250 PMCID: PMC2729986 DOI: 10.1007/s00228-009-0668-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Maurits E. L. Arbouw
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Kris L. L. Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Toine C. G. Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Arbouw MEL, Movig KLL, Guchelaar HJ, Poels PJE, van Vugt JPP, Neef C, Egberts TCG. Discontinuation of ropinirole and pramipexole in patients with Parkinson's disease: clinical practice versus clinical trials. Eur J Clin Pharmacol 2008; 64:1021-6. [PMID: 18626634 DOI: 10.1007/s00228-008-0518-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 05/27/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare characteristics and incidence of discontinuation of Parkinson's disease (PD) patients starting ropinirole or pramipexole in clinical practice with data from randomised controlled clinical trials (RCTs). METHODS Included in the retrospective clinical-practice cohort were first-time users of ropinirole or pramipexole diagnosed with PD before 2005. Baseline characteristics and incidence of discontinuation were compared between the clinical-practice cohort and RCTs. Treatment discontinuation was defined as more than 180 days between two refills of ropinirole or pramipexole. The incidence of discontinuation in RCTs was based on the reported rate of discontinuation for any cause. RESULTS Included were 45 patients who started with ropinirole and 59 patients who started with pramipexole. Treatment was discontinued within 3 years in 51% (ropinirole) and 60% (pramipexole) of the patients. Ten RCTs with ropinirole and 12 with pramipexole were identified. Baseline characteristics did not differ between the clinical-practice cohort and RCTs. RCTs reported discontinuation rates comparable with those at the same timepoint in the clinical practice until 1 year of follow-up. CONCLUSION This study shows that the overall incidence of discontinuation of ropinirole and pramipexole between the patients in our clinical-practice cohort and patients in the RCTs was comparable for the short term. However for the long term, discontinuation in practice is possibly higher.
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Affiliation(s)
- Maurits E L Arbouw
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
Pharmacotherapy is the mainstay in the treatment of Parkinson's disease and the armamentarium of drugs available for the therapy of this disease is still expanding. Anti-Parkinson's disease drugs are effective in reducing the physical symptoms, such as hypokinesia, bradykinesia, rigidity and tremor. However, there is a large interindividual variability in response to anti-Parkinson's disease drugs with respect to both drug efficacy and toxicity. It is thought that genetic variability in genes encoding drug-metabolizing enzymes, drug receptors and proteins involved in pathway signaling is an important factor in determining interindividual variability in drug response. Pharmacogenetics aims at identifying genetic markers associated with drug response. Ideally, knowledge of these genetic markers will enable us to predict an individual's drug response in terms of both efficacy and toxicity. The role of pharmacogenetics in the treatment of Parkinson's disease is relatively unexplored. Therefore, we aim to present a systematic review of the published pharmacogenetic studies in Parkinson's disease and to describe polymorphic genes of interest for future research.
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Affiliation(s)
- Maurits E L Arbouw
- Utrecht University, Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Sciences, Utrecht, The Netherlands
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Arbouw MEL, Movig KLL, Neef C, Guchelaar HJ, Egberts TCG. Influence of initial use of serotonergic antidepressants on antiparkinsonian drug use in levodopa-using patients. Eur J Clin Pharmacol 2007; 63:181-7. [PMID: 17200834 DOI: 10.1007/s00228-006-0233-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 10/25/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess whether there is an association between initial use of serotonergic antidepressants and changes in antiparkinsonian drug treatment. METHODS A retrospective cohort study was performed with the PHARMO record linkage system. All patients from 1994 until 2004 of 40 years or older who were first time users of an antidepressant and who had used a levodopa-containing drug at least 180 days before initiation of the antidepressant were included. The maximum follow-up time was 180 days. The first change in antiparkinsonian drug treatment, defined as an increase in the daily dosage of any antiparkinsonian drug, the start of a new antiparkinsonian drug or a change in the dosage form during the follow-up period, was taken as an endpoint. Antidepressants were classified in two ways: according to their class [selective serotonin reuptake inhibitors (SSRI), tricyclic antidepressants (TCA) or other antidepressants] or by the extent of their inhibition of serotonin reuptake (high, intermediate or low). RESULTS A total of 221 patients was included in our study. The adjusted hazard ratio for a change in antiparkinsonian drug treatment was 0.7 (95% CI 0.3-1.5) comparing SSRI with TCA users, and it was 0.9 (95% CI 0.4-2.1) comparing users of other antidepressants with TCA users. The adjusted hazard ratio for a change in antiparkinsonian drug treatment was 0.6 (95% CI 0.3-1.4) comparing users of antidepressants with high versus low extent of inhibition of serotonin reuptake, and it was 0.7 (95% CI 0.3-1.4) comparing users of antidepressants with intermediate versus low extent of inhibition of serotonin reuptake. CONCLUSION Based on these observations, we found no evidence to be more cautious using SSRIs or serotonergic antidepressants compared to other antidepressants in patients with Parkinson's disease.
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Affiliation(s)
- Maurits E L Arbouw
- Faculty of Science, Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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